Has This Study Finally Settled the Debate on Supplements?
Heart Health
December 28, 2022
Has This Study Finally Settled the Debate on Supplements?

Maintaining healthy cholesterol levels is a great way to keep your heart healthy. It can lower your chances of getting heart disease or having a stroke. Many people believe that common dietary supplements — fish oil, garlic, cinnamon, turmeric, plant sterols and red yeast rice — will lower their “bad” cholesterol. However, research from a new study shows that the six most common heart health supplements don’t help to lower bad cholesterol or improve cardiovascular health.

The study, which was published in the Journal of the American College of Cardiology, compared the impact of these popular supplements to the impact of a low-dose statin, which is commonly prescribed to lower cholesterol. A placebo group was also used as a control.

Study participants were ages 40 to 75, and different groups got a low-dose statin called rosuvastatin, a placebo, fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice for 28 days.

The statin had the greatest impact and significantly lowered LDL compared with the supplements and placebo. The average LDL reduction after 28 days on the statin was nearly 40%. The statin also had the added benefit of reducing total cholesterol, which dropped on average by 24%, and reducing blood triglycerides, which dropped 19%

“There have been prior studies showing little beneficial effect when it comes to supplements, but this study establishes their lack of effectiveness more clearly than ever before,” says Mark Peterman, M.D., an interventional cardiologist on the medical staff at Texas Health Dallas, Plano, Allen and Frisco. “Since supplements do not have a pharmaceutical company behind them willing to spend a lot of money doing a large, blinded analysis, we are often left to make judgments based on small studies which are not placebo-controlled.”

While some studies have shown promising results when it comes to supplement use, even leading physicians and health organizations alike to recommend supplements for preventive measures, Peterman says the lack of longstanding, unbiased studies can give misleading results, and therefore misleading enthusiasm surrounding the benefits of supplement use.

“Unfortunately, initial studies can show signs of benefit and without more rigorous evaluation, results can be misleading,” he adds. “When tested more rigorously, most of these supplements do not end up showing benefit despite initial enthusiasm. However, this does not diminish the importance of eating a well-balanced diet, exercising, and maintaining a healthy weight and the positive effects it can have on your cardiovascular health.”

Many people turn to supplements as a natural alternative to traditional pharmaceuticals, or believe that they will have fewer unwanted side effects or risks, but this study paints a different picture.

The test group that was taking supplements had similar results to those in the placebo group, yet they had the most adverse side effects out of everyone in the study, especially when it came to red yeast rice and plant sterols.

“Many patients have personal or family member experiences with traditional pharmaceuticals that are very negative and create an emotional barrier to use in which they gravitate towards supplements instead. But the reality is that many supplements contain unregulated amounts of pharmaceuticals and these are just as likely to cause side effects as pharmaceutical drugs,” Peterman explains. “There is a bias toward ‘natural’ therapies, but every chemical regardless of its origin can have effects on your body that need to be taken into account. Unfortunately, with supplements, you really don’t know exactly what you are getting since there is no FDA oversight of these agents.”

Additionally, critics of the study point out that 28 days is not a long enough time frame to produce strong and accurate test results. Many point out that the sample size for the test was too small as well.

“The study is certainly not as large or as lengthy as we would like to make a definitive assessment, but since most drugs are discontinued by patients in the first few weeks, it is applicable and the results are striking in their consistency.”

According to the American Heart Association, nearly a quarter of those prescribed a statin for primary prevention, and nearly 43% of those prescribed a statin for secondary prevention, discontinue use. The most common concern regarded possible side effects.

However, Peterman adds that the research helps provide some helpful evidence regarding common questions patients ask about supplement use versus traditional medication.

“We generally try to set realistic expectations for supplements and try to get patients to set timelines and expectations for their effectiveness so as not to just assume they are helping,” he explains. “It’s been my experience that the most highly promoted and advertised supplements are money-making schemes not real medical solutions for concerned patients.”

Furthermore, in 2022, the US Preventive Services Task Force updated guidelines regarding vitamin, mineral and multivitamin recommendations, stating they weren’t likely to protect you from cancer, heart disease or overall mortality.

“Patients always ask about supplements in lieu of or in addition to statins,” says Amit Khera, M.D., a cardiologist, professor and director of preventive cardiology at UT Southwestern Medical Center. “I think if you have high-quality evidence and a well-done study it is really critical to help inform patients about the value, or in this case the lack of value, for some of these supplements for cholesterol lowering.”

Khera adds that there are decades worth of research and study that shows statins not only work but help to lower risk.

“That does not mean they’re perfect,” he says. “That doesn’t mean everyone needs one, but for those at higher risk, we know they work and that’s well proven. If you’re going to do something different you have to make sure it works. That’s what this study does.”

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